Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology

doi:10.5847/wjem.j.1920-8642.2018.04.004

Abstract

Abstract:

BACKGROUND: To evaluate the utilization of point-of-care ultrasound (POCUS) for the assessment of emergency department (ED) patients with musculoskeletal symptoms and the impact of musculoskeletal POCUS on medical decision-making and patient management in the ED.
METHODS: This was a retrospective review of ED patients presenting with musculoskeletal symptoms who received a POCUS over a 3.5-year period. An ED POCUS database was reviewed for musculoskeletal POCUS examinations used for medical decision-making. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of musculoskeletal POCUS on patient management in ED.
RESULTS: A total of 264 subjects (92 females, 172 males) and 292 musculoskeletal POCUS examinations were included in the final analysis. Most common symptomatic sites were knee (31.8%) and ankle (16.3%). Joint effusion was the most common finding on musculoskeletal POCUS, noted in 33.7% of the patients, and subcutaneous edema/cobblestoning was found in 10.2% of the patients. Muscle or tendon rupture was found in 2.3% of the patients, and 1.9% of the patients had joint dislocation. Bursitis or bursa fluid was found in 3.4% of patients, and tendonitis/tendinopathy was found in 2.3%. Twenty percent of them were ultrasound-guided musculoskeletal procedures, and most of them (73.3%) were arthrocentesis. Of the included studies, all except three either changed or helped guide patient management as documented in the patients’ medical records.
CONCLUSION: Our study findings illustrate the utility of POCUS in the evaluation of a variety of musculoskeletal pathologies in the ED.

Key words: Point-of-care ultrasound, Musculoskeletal, Emergency department

Elaine Situ-LaCasse, Ryan W. Grieger, Stephen Crabbe, Anna L. Waterbrook, Lucas Friedman, Srikar Adhikari. Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology[J]. World Journal of Emergency Medicine, 2018, 9(4): 262-266.

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References 20

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Findings on POCUS	Frequency (%)
Effusion	33.7
Subcutaneous edema/Cobblestoning	10.2
Abscess	6.0
Cellulitis	4.9
Soft-tissue swelling	4.5
Bursa fluid collection/Bursitis	3.4
Hematoma	2.2
Tendonitis/Tendinopathy/Tenosynovitis	2.2
Muscle/Tendon rupture/Tear	2.2
Dislocation	1.8
Cyst	1.5
Fluid collection	1.1
Fasciitis	1.1
Air/Gas	0.7
Foreign body	0.7
Fracture	0.7
Necrotizing fasciitis	0.7
Bony erosion	0.3
Hemarthrosis	0.3
Osteoarthritis	0.3
Pseudoaneurysm	0.3
Thrombophlebitis	0.3
No acute musculoskeletal abnormalities	21.0

Musculoskeletal procedures	Frequency (%)
Arthrocentesis/joint aspiration	73.3
Incision & drainage of abscess/fluid collection	16.0
Reduction of joint dislocation	6.7
Non-joint fluid aspiration	2.7
Foreign body removal	0.4